Rheumatoid arthritis (RA) is a chronic autoimmune and inflammatory disease characterized by joint involvement as well as systemic features. This systemic disease is marked by inflammation, progressive cartilage, and bone destruction. While genetic predisposition plays a role, environmental factors, including diet, are increasingly recognized as central to disease risk and progression. This article delves into the role of diet in RA, with a focus on the Patterson Diet and other nutritional strategies for managing this condition.
Understanding Rheumatoid Arthritis and the Role of Diet
The global prevalence of RA is estimated around 1-2%, with a large variation among different populations. Genetic and environmental factors interact during RA pathogenesis, a multistep process that begins years before clinical onset of the disease. The most relevant genetic risk locus associated to RA is found in the HLA class II molecule-encoding locus (chromosomal position 6p21.3).
In genetically predisposed individuals, the influence of environmental factors can lead to a breaking of immune tolerance to self-antigens, including citrullinated and carbamylated proteins. Several environmental factors, such as cigarette smoking, air pollution, dust, diet, and infections, contribute to the development of systemic autoimmunity and autoantibodies appearance years before the onset of symptoms.
In recent years, an increasing number of studies have investigated the role of diet and nutrition as potential tools for RA prevention and management. It can be assumed that the Mediterranean Diet (MD), together with genetic and other lifestyle factors, could explain the lower RA incidence in Southern Europe (0.3-0.7%) compared with Northern Europe and North America (0.5-1.1%).
Dietary habits could represent both disease risk and protective factors, based on the properties of specific foods. Specific dietary choices can indeed show pro-inflammatory effects (for example, red meat, salt, excessive caloric intake) or, on the contrary, reduce inflammation (oil, fatty fish, fruit, and others). The Western diet, characterized by a high intake of red meat, saturated and trans fats, a low ratio of omega-3:omega-6 fatty acids, and high consumption of refined carbohydrates, has been associated with an increased RA risk principally through an increase of inflammation and an induction of insulin-resistance and obesity.
Read also: The Hoxsey Diet
RA shares inflammation as a driving pathophysiological process with other chronic diseases, including cardiovascular disease (CVD), type 2 diabetes mellitus, different types of cancer, and Alzheimer’s disease. Nutrients can modulate the inflammatory status of humans, and consequently, the pro- or anti-inflammatory properties of specific foods and components have emerged in nutrition sciences.
The Patterson Diet: A Lifestyle Approach to Managing RA
The Paddison Program claims it can reverse RA symptoms, but it is not an evidence-based diet recommended for any condition by Arthritis NZ. Even so, Ane wanted to explore the diet in more detail and give it a go based on the possibility that it might make a difference to her symptoms as other people, including the program’s founder, Clint Paddison, have experienced.
The Paddison Program is a step-by-step guide for reducing disease activity in rheumatoid arthritis (RA) through diet, supplements, exercise, and stress reduction. The program was started by Clint Paddison, who treated his RA by studying the science behind the condition. He then made major lifestyle changes (especially through diet) that reversed his disease and allowed him to stop taking medication for RA.
The underlying principle of the Paddison Program is that diet, the gut biome, and intestinal health are at the core of a healthy immune system. The Paddison Program emphasizes that RA disease activity is affected by gut bacteria, leaky gut, enzymes, and the mucosal lining of the intestine, among other factors.
The Paddison Program is just that - a programme. It’s not just a diet, it’s a way of life. It consists of an elimination “diet” which starts with a 2-day “cleanse” followed by 2 weeks of “baseline” eating before beginning re-introducing foods (I believe this is now only one week). Its focus is plant-based eating to heal your gut and cutting out inflammatory foods like meat, dairy, oil and processed foods.
Read also: Walnut Keto Guide
The program has been endorsed by several medical doctors who advocate dietary changes and other lifestyle factors as the main part of overcoming disease and staying healthy. The fee-based program aims to help participants boost their immune health, eliminate RA symptoms, and reduce or stop medications.
Key Components of the Paddison Program:
- Dietary Changes: The program focuses on a plant-based diet to heal the gut and eliminate inflammatory foods like meat, dairy, oil, and processed foods.
- Supplementation: The program advises supplements.
- Exercise: The program emphasizes exercise for improving gut health in people with RA.
- Stress Reduction: Reducing stress through relaxation techniques and physical activity such as exercise may help improve RA symptoms and reduce inflammation.
Considerations Before Starting the Paddison Program
Ane decided she would like to keep a record of her journey, so that others in her position, who want to know what it’s like before trying, can read about her experience. Consult a registered dietitian if you want to make diet and lifestyle changes outside the American Rheumatology Guidelines.
If you are thinking about trying the Paddison Program, it is important to maintain your treatment plan as you start the program. Do not make changes to your medication without medical advice from your rheumatologist.
Anecdotal Evidence and Potential Benefits
Ane* has rheumatoid arthritis (RA) and was looking for additional lifestyle modifications she could make alongside her clinical treatment plan to manage her symptoms.
One member wrote, “I am doing the Paddison diet. I started the juice fast this weekend, and my joints feel great.”
Read also: Weight Loss with Low-FODMAP
Another member said, “I’ve been doing some research about diet, and for the past two months, I have been following a plan of no meat, dairy, sugar, gluten, or nightshades. I’m not sure I see a difference yet as far as feeling better, but I do feel good about how I’m eating, and I’ve lost weight! Have you heard of the Paddison diet?
Dietary Strategies for Managing RA
The Mediterranean Diet (MD)
The Mediterranean Diet (MD) features mainly vegetables, unrefined cereals, fruit, legumes, fish and extra-virgin olive oil, associated with a moderate intake of eggs, poultry, dairy products and low consumption of refined sugar and red meat. Red wine is also included, and herbs and spices are largely used. Featuring an omega3:omega 6 ratio of 1:7, related to a high intake of alfa-linolenic acid (ALA), a specific “anti-inflammatory” PUFA, MD is associated with a reduction in total and cardiovascular mortality, and cancer, Alzheimer’s and Parkinson’s disease incidence.
Research has shown that following a Mediterranean diet can improve symptoms of RA. This included reduced swollen and tender joints and duration of morning stiffness. The MD is a healthy way to eat in general and will have positive impacts above and beyond arthritis. A MD diet can increase weight loss and lower the risk of diabetes and cardiovascular disease. It can also lower the risk of certain cancers.
Increase colourful fruit and vegetables in each meal. Aim for one half to two thirds of the plate to be non-starch vegetables. This includes greens, mushrooms, squashes, beets, cauliflower or broccoli. Eat fish, especially oily fish (important enough to have its own section). Research shows that omega 3 is important for brain development and function. Focus on whole grains like quinoa, brown rice and bulgur wheat.
Foods to Limit or Avoid
- Red Meat: Excessive consumption of red meat and a high total protein supply have been associated with an increased risk of inflammatory polyarthritis.
- Processed Meats: Red meat can increase inflammation, especially processed meats (e.g., sausages or bacon).
- Refined Grains: Refined grains such as white flour, white rice and flour based foods.
- Sugary Drinks: High sugary drinks consumption has been associated with RA development.
- Alcohol: Alcohol also has a high calorie content and can contribute to weight gain.
The Importance of Gut Health
Our gut is home to trillions of bacteria, viruses and fungi. We call this our gut ‘microbiome’. The gut microbiome’s relationship with the immune system impacts autoimmune diseases. Dysbiosis is an imbalance of ‘friendly’ vs ‘unfriendly’ bacteria in the gut. This imbalance can lead to increased inflammation in the gut. Dysbiosis can also cause leaky gut syndrome.
It’s vital to keep a healthy microbiome and what you eat matters. You are eating for two - for you and for your bacteria! Increase fibre-rich foods (see Table 1), prebiotic foods and fermented foods. Fermented foods are probiotic foods which can feed the bugs we wish to increase and crowd out those we don’t want. Take out refined carbohydrates, sugars and processed foods.
Dietary Fibre Sources
'high in fibre' = more than 6g fibre per 100g a 'source of fibre' = at least 3g fibre per 100g.
- Wheat
- Rice
- Oats
- Corn
- Rye
- Barley
- Millets
- Sorghum
- Wholegrain pasta
- Wholegrain bread
- Porridge
- Oat bran
- High fibre breakfast cereals
- Potato skins
- Sweet potato
- Beans - baked beans, chickpeas
- Pulses
- Vegetables
- Fruits, especially where you eat the skin and seeds
- Seeds, e.g. linseeds, chia seeds, sunflower
- Nuts, e.g. almonds, hazelnuts, peanut butter
Omega-3 Fatty Acids
Omega 3 fatty acids play an important role in the inflammatory response in the body. Evidence suggests that omega 3 (from oily fish or supplements) can improve RA/JIA symptoms. The amount of omega 3 fats necessary to improve your RA/JIA symptoms is around 3g per day.
Natural sources of omega 3 fatty acids are oily fish such as mackerel and fresh (not tinned) tuna. Smaller fish are better sources of omega 3. Eating oily fish 2 or 3 times a week provides a reasonable intake of omega 3. Omega 3 can also come from plant sources such as linseed and evening primrose.
Antioxidants
Antioxidants are substances that can prevent or delay some types of cell damage. Fruits and vegetables contain antioxidants. Eating foods which are rich in antioxidants on a regular basis can benefit your health. Brightly coloured varieties of fruit and vegetables are particularly good sources of antioxidants.
When inflammation occurs in RA, your immune system produces substances called ‘free radicals’. These can be harmful to your body. Antioxidants found in brightly coloured fruit and vegetables can help limit this damage. They can also have an anti-inflammatory effect. Aim to ‘eat the rainbow’ and have at least three colours of fruit or vegetables in each meal.
Vitamin D and Calcium
Use of steroid medication can increase the risk of osteoporosis (a weakening of the bones). This is because steroids can prevent the body from absorbing calcium as it should. Choose organic whole milk. If using soya milk or other alternatives, use calcium-enriched products. Remember, soya milk on its own contains no calcium.
Vitamin D deficiency is more common in people with RA. Evidence suggests this can lead to more rapid disease progression. It is important for anyone with an auto-immune condition to check their vitamin D levels. If taking vitamin D supplements, check these levels every three months.
Gluten-Free Diet
A study in BMC Gastroenterology demonstrated the benefits of a gluten free diet. The study found improved symptoms and lowered inflammation for those with gluten intolerances. If you think you may have an issue with gluten then please speak to your GP. They can test you for coeliac disease, as there is evidence that those with RA and JIA may be more prone to it.
Supplements
There is a lot of evidence to show that some supplements can help to improve RA/JIA. This may be through anti-inflammatory and anti-oxidation effects or by supporting the joints. Before taking any supplements you should seek the guidance of a health professional. Check with your rheumatology team that the supplement won’t interfere with your medication. Methotrexate lowers levels of a vitamin called ‘folic acid’. Folic acid supplements are usually prescribed alongside methotrexate to top these levels up.
Other Important Considerations
Exercise
Exercise plays an important role in managing RA and JIA. A good exercise routine can improve joint function and reduce stiffness and inflammation. Exercise can increase the function of synovial fluid, which sits inside the joint. Synovial fluid helps protect joints and reduces friction between bones. Exercise can also lower pro-inflammatory proteins called cytokines, which play an important role in your immune system. The best exercise is the one that you do.
Monitoring Your Diet and Symptoms
Making changes to diet and adding supplements is very individual. A food and symptom diary can help you to identify food types that may worsen your RA/JIA symptoms.
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